The limits are 8 tablets per day for 50 mg and 100 mg tablets. Demerol 50 mg/5 mL solution has a limit of 80 mL/day.

DESVENLAFAXINE SR 24HR

07/01/13

The limits are 1 tablet per day.

DEXILANT™

07/01/10

Dexilant may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 tablet per day.

DIABENESE

04/01/12

The limits are 60 tablets per 30 days for 100mg and 90 tablets per 30 days for 250mg.

DIDANOSINE

07/01/12

The limits are 1 capsule per day.

DIFFERIN®

04/01/01

Prior authorization for medical necessity may be required.

DILAUDID

01/01/13

The limits are 6 tablets per day or 48 mL/day for the Dilaudid 1 mg/mL solution.

DIOVAN HCT®

01/01/11

Diovan HCT may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).

DIOVAN®

01/01/11

Diovan may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE Inhibitor or generic ARB.

DOLGIC PLUS

04/01/13

The limits are 5 tablets per day.

DOLOPHINE

01/01/13

The limits are 3 tablets per day.

DORYX®

11/14/07

Doryx may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.

DOXYCYCLINE

04/01/13

Doxycycline may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.